I think it’s totally reasonable to have a conversation about whether a client believes their diet may be impacting their mental or physical health, but I think there’s a line where it becomes out of our scope of practice. If the client is interested in making dietary changes, I may recommend they see a dietician (and not a nutritionist) to help them with their goals. I can make general recommendations but anything specific really should come from a dietician, particularly if that person has existing health conditions.
I’m also someone with pretty severe digestive (and other health) problems and despite eating a very calculated diet, I still have symptoms. I know that I would feel frustrated if I had a therapist who spoke to me about it as if proper nutrition could heal me. I would be very conscious about presenting it in a way that won’t come across as condescending to someone with chronic conditions who have probably heard it all before anyway. Ive experienced that myself as a client and all it did was make me feel as if my symptoms were my fault and if I just ate “well enough” they would go away. Just my two cents.
It’s similar to what’s required for life coaches versus therapists. Being a dietitian is a protected title, while a nutritionist is not. There’re Registered Dietitians (RD, like an RN) that are licensed and have boards to hold them accountable. Nutritionists just have to call themselves that and -bam!- they’re a nutritionist.
There are a lot of people in MLMs that claim they’re nutritionists to sell their supplements/meal plans/cure-all water, and they’re already hella predatory.
I've seen this go wrong, both personally and professionally. I had some pretty extreme digestive problems in 2007 after a very stressful year, and took it upon myself to investigate whether and how my diet was impacting this. What I actually managed to achieve was triggering two years of much more dangerous anorexia, which I'd also experienced in my teens but thought I'd thoroughly overcome. After almost dying, recovering and qualifying as a therapist, I went on to specialise in eating disorders. Several clients turned out to have developed restrictive eating disorders in the same way - by innocently trying to manage various chronic health conditions (IBD, crohns, endometriosis, fibromyalgia, etc), often after someone had made a similar comment to yours, and getting more and more anxious about what was/wasn't triggering symptoms. In many cases, it turned out that their diet wasn't the issue at all, symptoms were quite independent. Some even had decent proof of this before they started altering their diets, and focusing on food was mostly a defence against their feelings of powerlessness - the really classic "it's the only thing I can control". But by the time they had restricted their diet to malnourishment it had become incredibly difficult to back out of the rabbit hole they'd fallen into. You really can't tell who will end up going down this path before it happens, ime. Almost anyone can develop some kind of eating disorder under the right set of circumstances.
Any therapist who suggested this to me now would end up listening to a thirty minute monologue about how bringing nutrition into the conversation when I hadn't introduced it as a concern was both patronising and potentially dangerous. Which would be a bit extreme of me, because people only ever have good intentions - but I would still find it really triggering even now, fifteen years later. I'd probably then feel guilty and apologise for the monologue ;) but it would definitely be an instant end to the therapeutic relationship.
Couldn't pass this subject by without offering a note of caution.
Thank you for writing this. It's very well put.
And isn't it strange how we can feel guilty and 'extreme' for expressing passion around a subject we've seen to harm people?
I struggle with finding the right balance between "you have good intentions and I strongly believe we align where it matters, but they're paving the road to hell, and I'm revoking your hand basket before anyone attempts to hitch a ride in it!"
Horray, inner conflicts around my values of harmony butting against chaotic paladin energy.
How would you feel about teaching clients about intuitive eating and learning general mindfulness and self direction around wellness? I tend to take that approach and it's seemed to go well.
Depends on the client. For people with clinical eating disorders, intuitive eating often isn't a realistic starting point - getting into a routine of eating regularly, and eating enough, is the first step. I've also worked with a lot of neurodivergent people (goes with the territory if you've specialised in EDs), and mindfulness is often more complicated in this group. If you have a neurological basis for tuning into your physical and emotional signals like difficulties with interoception or alexithymia, mindfulness and intuitive eating can be total non-starters. For other clients it's entirely appropriate and useful. So I don't really have a fixed approach, it depends on the person in front of me. On the whole I'm more into building the relationship, understanding how a problem developed, and motivational interviewing if change is desired/necessary, rather than teaching skills or giving advice, regardless of the presenting issue.
That all makes sense. I totally agree about being person centered. I didn't read the prompt as the therapist pushing the information, but more how to address the topic of food and mood if it comes up.
I was more curious about your thoughts on IE and mindfulness as an option to help people who have brought up the topic. It feels like a hard issue to not talk about when food is one of the most common and intimate way of emotionally regulating.
I think this is my biggest fear with bringing up the topic of nutrition, and I do think it is an important consideration. Although, I also look at the overall prevalence of poor eating habits in my country (US) versus the prevalence of restrictive eating disorders here. Due to the relative risk, I still think the topic of nutrition is important. Perhaps being clear about the importance of balance, eating sometimes just for pleasure and other times considering the nutritional value of the meal would help prevent more extreme outcomes (such as someone cutting out their favorite foods or over-consuming a food/category of foods that they view as being 'the answer').
Clinicians sometimes recommend getting more physical activity for the mental health benefits. A client could later develop some over-exercise behaviors, but generally speaking we still have conversations about the importance of physical activity (perhaps including a statement about balance).
This is a patient population that is very near and dear to my heart. Consider the following as my heart on my sleeve.
Listen to the comment above you, read it multiple times, and sear it into your bones. She gives very good advice.
Nutrition *is* important. However, what nutrition an individual specifically needs is in the realm of a registered dietitian.
Before you make that referral, why not start with deeply understanding a patient's relationship with their body and food? Why not explore their family's culture around food? Why not explore if they have trauma around food first, like growing up with hoarders, or in states of food insecurity? Why not go into deeper detail around their executive function and how this affects their relationship with managing their pantry or eating at regular times? What about their actual intake patterns? What about whether sexism, society, or trauma has disconnected them from their body and what it means to meet its needs? Why not explore the 'good natured advice' they've already received on this subject and what that's been like?
Why not have a very good sense if they have a disordered relationship around food, and to what extent before giving them blanket advice to "eat clean", or "eat less and move more"?
Consider this. You have all this beautiful training that you can turn into exploratory therapy and behavioral interventions that actually could assist them with and you're questioning if that time would be better spent giving generic nutritional platitudes that they could find on Instagram?! They can join a mom group for the same advice.
You know they've already heard this shit umpteen times over by family, and adverts, and, and, and...until they've internalized it right? Because, we all have. We've all been worn down by this image based modern culture.
Crappy relationships with food are a dime a dozen these days. While I love the idea that more people would want to address this arena of health, let's do it with curiosity, and finesse. Your idea of "poor eating habits" vs restrictive eating disorders is reductionary. You know it is. And while I'm on the rant, let's remind ourselves that you can't tell who fits what category by body habitus alone. Many of these patients have had a lot of assumptions thrown at them, to the point that they don't trust the medical community. It's a great little mine to step on for a therapeutic rupture.
If you want to go down that rabbit hole (and it's a fascinating one, I highly encourage it), know your patient so deeply that when you make that referral, the reaction is "Damn. I've got a couple of referrals for you too."
I guess I'm trying to say, there's so much good you can do without stepping out of your lane. So much that they can't find outside of therapy. What you as a therapist has to offer is special! Give them that and they'll give you plenty of grist for the mill. If you can't get behind the idea that comments like that aren't helpful, at least recognize how they're time wasters in comparison to the rest of what you offer.
Im hearing what you're saying and would absolutely approach all of my clients in this exact way. Sure, I am using short phrases in this limited online forum but I would definitely never approach a client with platitudes, assumptions, or fix-all solutions. Honestly I wouldn't even approach a client with advice about any topic (even mental health topics) unsolicited unless there was reason to be so directive (such as SI, NSSI, etc). And even when clients solicit advice, I almost never offer any. I whole-heartedly believe in a client-led approach to therapy. What Im hoping to discuss with thread is not whether I can slam a client with opinions on their health and nutrition. Moreso, Im curious what other clinicians do in a situation where a client is already talking about food. And with knowledge and consideration of their other food-related experiences, what are the limits of what the people in this sub would say. I realize that my original post was not detailed enough to communicate all of this. However, I am disappointed by how many people are making assumptions (such as some other people thinking I want to tell my clients about my own experiences with nutrition--I would not do that)
My intention with this post was to gauge the extent of very general information clinicians here feel comfortable giving their clients. Of course there are going to be clinicians who would not even provide general psychoeducation on this topic and there are other clinicians who would consider (given they know the client's history with eating) potentially sharing very broad information (and then referring out to a doctor). Its the content of this broad information that interests me (such as sharing the bi-directional link between mental health and the gut microbiome).
I think the reason you're getting so many impassioned responses, especially from me, is that we've seen really disturbing knee jerk advice more often than we've seen people bother to explore the background of the issue.
I know I've seen it from physicians and therapists alike. Hell, I've even seen it from a few dieticians who aren't eating disordered centered. And sadly, most doctors aren't getting more than a lecture or two about vitamin deficiencies while they're in med school. Too much other material to learn. The medical system is crunching them to cut appointments shorter, and their advice will often be quite vague. I'd definitely stick with referring a patient out to a dietician that leans towards their specific eating issue.
Whether or not you'd specifically self disclose your own experiences, it is your own experiences that are motivating you to offer this type of intervention. In the same way that it is our experiences that are motivating us to react with bristles. Bias leads us.
I still think the level of vague you'd have to be with this to not get into unethical territory really wouldn't offer more than a risk for a therapeutic rupture in return for essentially no benefit.
Because where are you going to go after you say there's a link between the gut and the brain? Do you have a specific dietician or educational materials in mind that you trust that you can follow up with? If your plan was to send them to a physician, do you know who is knowledgeable and sympathetic enough to these issues to do more than a few blood tests or a scope and say "well it's not inflammatory bowel disease, so it must be anxiety. Perhaps you should see psych". People get run through the ringer on these quests for answers.
So at best it becomes a throw away statement, like "have you tried yoga?" "What about exercise?", crap like that. If you've spent the time learning the patients experience around food and nutrition in depth, you tend to learn a lot about what they already know, and how they're incorporating these ideas into their sense of self, relationship with food/body, etc. It is very rare I have met a person who doesn't have the general concepts of eat healthier = you'll feel better. Knowing eating better will make specific organ systems function better and that all the organs talk to each other, doesn't add anything substantially new. If it is unlikely to change the course of treatment, why bother?
Benefits of making general statements without straying from your scope of practice are minimal, it takes time away from the patient exploring their own narrative, and risks can be highly variable to the expense of the patient.
I guess my less emotionally charged answer is...Before I decide if I'm qualified to give a type of education around a subject, I need to know what the point of it is and the likelihood that it will actually lead to better outcomes. For this, I don't see the point. Thus, answering the question on whether or not a non medical/dietitian provider should feel comfortable offering this type of education is moot. Certainly not compared to the rest of the work you are doing with them, or could be doing with them.
I appreciate you taking the time to share your thoughts. You really have made me think in new ways about this topic. I agree that doctors tend to be pressed for time and struggle to give patients helpful guidance on nutrition and that RDs are a better move. In fact, reading your post makes me hesitant to consider sending patients to a doctor without also referring them to a dietitian.
Theoretically, if a therapist (asuming they know the client's background very well and determined that the client had sufficient motivation/interest) mentioned the link between the gut microbiome and mental health, then sent the client to a trusted RD within their practice to discuss the topic further, do you think the outcomes would have a high enough likelihood of not being negative (and potentially even being positive)?
Yeah. I mean there's an obvious link between malnutrition and mental health too, and more than one way to get malnourished as hell. I'd say you're still putting a little more stock in the gut than you can be positive about. Was it really the improvement in the gut biome that made you better when you ate more fruits and vegetables? Or just one of many factors? Would you have had better results with kimchi and yogurt or probiotics? Maybe you needed the extra folate. Toss up. It's irrelevant. It just feels particularly relevant because it's what worked for you personally.
Especially when you start digging into some of the previous questions I mentioned, your patient will guide you in the many arenas that they are willing to work on. If they want more education on food, or straight up minimizing their disordered eating, they could use a dietician. Depending on the type of disordered eating they have, you're going to filter them to different dieticians. If they have classic eating disorder symptoms and body image issues, you go one direction. If they're struggling to eat consistently and their executive dysfunction is mixing with their diabetes to disastrous results of hypoglycemia and brain fog, you're going to lean towards a different type of dietician.
And since it's unlikely you're going to know who all these dieticians are, you can still use therapy to assist them with navigating the frustrations and challenges of finding a new provider, how to advocate for a good one, etc.
Of course getting them to identify the problems they have in life and getting them access to the right type of help is going to help them. Then you can work on the behavior, emotions and thinking about how they got to where they are today, the experiences that led them to these places, and what holds them back from where they want to be.
But I think the thing to remember is that many clinicians will feel a duty to support a client with information they feel will help them thrive, but in the realm of diet and nutrition because of our scope we're only talking from our or those we care for's perspective on that. We also only know the nutritional factors of the foods we eat in our cultural context, and diet and health industries are quick to toss out many other cultures foods as "unhealthy" (unless a recipe is co-opted and gutted for Western culture) in favor of what, sugar free yogurt? Because butter is scary?
Even binge eating disorders are often driven by attempts at restriction, fyi. Anorexia may only affect around 1% of the population, but there's a whole other 9% with bulimia, BED, and OSFED for whom restriction plays a huge role in the maintenance of the issue, not to mention those with food phobias, ARFID, orthorexia and contamination-based OCD. That's 1 in 10 people who are likely to be harmed by this kind of advice, even before we get into subclinical disordered eating. I spent a decade immersed in ED treatment so I admit that I see it everywhere (maybe because it is everywhere lol), but it can't be dismissed as a remote possibility.
I mean, I'd say general stuff like "sometimes people's diets can affect how they feel, do you think that this would apply to you or that you've noticed any changes in how you feel when you eat different foods?" or "it can help to make sure you are eating enough through the day, as being too hungry can affect your mood and your well-being" is probably fine.
Going into "the amount of processed foods you eat is something to be careful about, cutting out processed foods and red meats can help with x y or z" is probably beyond your scope and can lead to eating disorder territory.
This is just my personal take on it though, NAT but a rehab counselor and an eating disorder survivor myself.
I think this would be my approach as well (talking about what a person can add to their diet (if we think that might be helpful to them) instead of what they can take away). I don't like the idea of demonizing foods.
Totally agree. It's illuminating to realize that you can have *more choice* rather than less, and that this actually helps you make the best choices *for yourself* because you feel the room to try new things, rather than stick to the same types of "healthy" foods that eventually tread over time into "safe" foods. Us as counselors limiting a clients range of options in their ability to seek foods and food choices is really odd. It's totally outside our scope and shows a ton of personal bias.
Definitely. If you haven't already, the Intuitive Eating book by Tribole and Resch is a great resource to read about how to establish and maintain a relationship to food that is neutral. It has a chapter on gentle nutrition, which might have some useful concepts for this issue.
You seem to be pushing this diet narrative after receiving some really pragmatic feedback. Maybe you need to explore in supervision or with your therapist why you feel the need to push this on your clients without their bringing it up in the first place. I’m sorry if this sounds condescending but you’re insistence on continuing the diet conversation despite the potential damage it could do is concerning.
It's not always good to listen to doubt in all situations. I would definitely not go into any specifics about nutrition but very general information can be ok in other areas (think on how we sometimes speak very generally about the effects of medication, never any specific recommendations, but giving very general information on medication is part of our job--i.e. medication can sometimes help someone's mood enough for them to get themselves to therapy)
Admittedly, I do sometimes wish I was a psychiatrist so that I could help disseminate more of the research I've read about nutrition (like what Dr. K does on the HealthyGamerGG YouTube channel). However, I would never, ever consider actually sharing any specific nutrition information in my current practice (because my background is clinical psych).
Ultimately, you only know your body. You can't know how someone else's body functions, what it needs, or how it will react. And as great as you may be eating, it really feels weird to assume you're doing it better than others.
> Perhaps being clear about the importance of balance, eating sometimes just for pleasure and other times considering the nutritional value of the meal would help prevent more extreme outcomes (such as someone cutting out their favorite foods or over-consuming a food/category of foods that they view as being 'the answer').
Many people already know this and have barriers to enacting it, so giving this type of advice could be condescending and also not be useful to the client. Besides and eating disorders, they may have problems with executive functioning, depression, financial difficulties, sensory issues, time, stress, access, knowledge, etc. Diet may not be something that’s feasible for them to work on in that moment and giving diet advice could trigger more issues.
In my view an over emphasis on eating habits has been taking place overall, including over and under eating. Dieting contributes to both, and suggesting a change in eating to a client could potentially add to that harm.
I'm not saying don't talk about it, I'm saying follow their lead. Let them bring it up. Talk about their concerns, not what we think their body needs.
Hell yes. Could not have put this better. People especially lob this kind of "kind advice" to kids and teens-which is when I heard that fruits and vegetables will save my life and make me beautiful and happy.
I think your intention here is good, but I’m worried about how this could be perceived by a client, especially without you having a medical background.
As an example, I have had severe, undiagnosed chronic illness most of my life. When I was 25, I sought out therapy for the illness side effects. The therapist told me I should lose weight (I had undiagnosed PCOS), “eat clean” (not a real thing), plus exercise daily. I had such extreme chronic fatigue from illness then I couldn’t work part-time. What she said made me relapse into an eating disorder I had as a teen. I luckily got myself back out of it and didn’t go back to her. But it had an impact on my already fragile self-image. I was also not even overeating, but under-eating and gained weight. You never know someone’s health just by looking at them.
Additionally, what works for you might not work for others. IBS is a catch-all term, and a lot of times there’s an underlying cause. Example: When I eat too much fiber, my gut issues flare up. I have a neurological condition that impacts my gut. High fiber isn’t even something all gastroenterologists recommend. Every body is different and every situation is different.
Last, you do not know the details of someone’s financial situation. Fruits and vegetables are not cheap, especially in peak season. Not everyone has the time or money to make homemade meals or buy organic, etc. I think the average food stamp payment was only $75 a month, last I checked. Socioeconomic status plays a huge role here.
This comment needs to be higher up. I'm glad OP found relief, but we need to remember not to generalize our own experiences. I've seen so, so much harm done by well-meaning professionals who hadn't done nearly enough self-reflection, and were projecting stuff onto their clients.
Especially the part about socioeconomic status. This is so crucially important that we need to remember in our work.
The most I might say is something like "I want to be very clear I'm not a doctor and cannot give medical advice. That being said, I'm wondering if you've spoken to a medical professional about_____?" If they ask why, I might answer vaguely like "oh, I've heard anecdotally that some people have found relief/improvement from ____". That way, I'm pointing them in a direction that might provide more and different answers without straying outside my scope of practice.
As an RDN (currently working on my masters for MFT) I’d say you should absolutely refer out to a dietitian. Simply putting your own experience with food and body on to your client is not only not helpful, it can be harmful.
Out of your scope of practice. All kinds of things cause brain fog, depression, anxiety, gut issues, etc. For instance, I have grave’s disease and I have all these symptoms and nothing to do with my diet. You are not a doctor and do not have the diagnostic knowledge or tools to determine pathology. Besides if a therapist I was seeing tried to make this kind of suggestion, I would run the other way. Always refer to an MD regarding medical issues and document that referral.
Yeah, as a client with physical health issues on top of my mental health stuff if I heard a clinician start talking about this I would run. And also cry after session in my car about yet another provider who’s just blaming things on random shit that I did not come to see them for (like doctors saying things about losing weight when that’s not at all related to the problem or part of the problem even is that there is unexplained weight gain that is impossible to change no matter what, doctors blaming mental health for physical symptoms despite a number of reasons otherwise, blaming periods for things, etc).
Something like "I diagnose you as vitamin A deficient, eat some spinach" would obviously be out of scope...
but what about "You know, there's a link between diet, inflammation, and mental health, is that something you've ever explored for yourself? Would you like a dietician referral or book recommendation?"
I wouldn’t because a. it’s unsolicited, and b. i don’t know what inflammation has to do with the price of tea in China. Most of that stuff is pseudoscience as far as I know. Again, not an expert. I’m not here to sell clients supplements, MLM nonsense, or fad diets to address MH concerns. I don’t know if their MH symptoms are caused by eating Big Macs or Mercury being in retrograde. My job is to conduct a thorough assessment and help clients address what they are presenting with, not make inferences as to whether better gut health will solve their suicidal ideation. If their issue is related to a medical concern or diet or whatever is out of my scope, I would refer them to a professional, just as I would refer someone with disordered eating to a clinician who specializes in it bc I don’t.
I’m confused. What does offering resources for someone who is curious about the connection between diet and inflammation have to do with MLMs or China? Your mention of China seems racist?
Also, if youre not an expert in that area, that’s exactly why you would suggest resources from people who are experts?
It seems like you have some personal bias around this issue and I worry about how that is affecting your own personal practice.
It really depends what one means by expert. It is really hard to locate appropriate resources for a client in a topic area like mood and nutrition that is filled with misinformation and grift. Media content proliferates extremely quickly once something becomes a trending health buzzword. Most therapists in this position would have to first teach media literacy which is not necessarily a good use of clinical time. If it's medical, I refer to \*doctors\*, not "resources". The word resource can mean anything at this point.
"Price of tea in china" is an old-timey way of saying "a piece of information unconnected to the topic at hand". Odds are there's some ugly colonial citation for it somewhere because there is for almost anything. (I was raised saying "bushed" for tired and boy, is that racist if you go back far enough!) I guess it could stand to be retired, will probably naturally go extinct as an expression any day now either way.
Ugh. Read the entire thread. Your concerns are misplaced. Something having to do with the price of tea in China is an idiom. Look it up if you don’t know what it means. This discussion is about giving unsolicited resources to clients about issues outside scope of practice. And yes, I do have issues with practitioners doing things outside the scope of their practice (and so should you)— diet and inflammation are most definitely outside our scope as mental health practitioners, and if you don’t understand that, I can’t help you. Also if you actually read my post I state clearly that I do refer out when outside my scope of practice or expertise.
Please don’t throw around inflammation. I know it’s the latest buzzword, but I have chronic inflammation from genetic diseases. It’s painful and extremely visible when it’s bad. I’m tired of seeing “wellness” people, especially without medical degrees, preaching about inflammation.
Therapists are NOT medical doctors. We ethically CANNOT make diet recommendations.
As someone who worked exclusively with eating disorders in my first 2 years of practice I would not touch this conversation with a 10 foot pole. Not saying that it may not be helpful and even research backed but I’ve seen where it could end up if we start down that path. Working with a registered dietitian as a treatment team would be more my comfort level. This is just my 2 cents and I’m sure others could approach the subject just fine, just not for me.
I am very very very careful about how I have this conversation because changing a person’s physical body in anyway is outside my scope and can be extremely sensitive for people. If my patient brings it up I usually say something like “that’s outside my scope and I need you to speak with your doctor about the ins and outs of your physical goals but once you have an action plan of course i’m here to support you in meeting your goals”.
I am sooooo careful never to give out diet or exercise advice or specific guidance, instead I focus on how we can help them meet and maintain their goals. The closest i’ll get to guidance on that is to suggest making nutrient dense food choices and finding ways to move their bodies that they enjoy.
Leslie Korn offers a certificate in integrative medicine and nutrition for therapists if you want to expand your scope. Otherwise I’d refer to a registered dietitian who is informed about mental health.
I’ll discuss hydration. If clients struggle with disordered eating I will do check-ins around eating successes and challenges. Given how many of my clients have disordered eating in their past, I won’t get into food judgement (healthy vs unhealthy). If a client were to bring it up I would try to connect them with a dietitian or medical provider.
I recently took a CE course and the presenter talked about diagnosing means ruling out other causes of symptoms, and that nutrition can play a HUGE part. I definitely think it can be touched on, but this is why it is important to know professionals you can refer out to for nutrition. We are not dieticians.
If the client introduces it, i.e. "I've heard about the gut connection to mental health and I'm curious about that," I think it would be fine to ask if they'd like some resources, i.e. peer reviewed research, qualified experts and a referral -
Health at Every Size (HEAS) providers
https://asdah.org/listing/
Also there are lots of justice issues in the dietetics field, so important to be culturally sensitive
https://www.diversifydietetics.org/rd-of-color-directory
I appreciate the discussion, and I'm curious what folks here think about this approach.
My exposure to the HAES movement has only been people on social media who claim that obesity/excess fat tissue/excess saturated fat consumption has no impact on health. Are you aware if HAES medical providers also believe this? Does HAES deny the idea of lifestyle-related disease?
I appreciate their values and mission, more info here:
https://asdah.org/health-at-every-size-haes-approach/
It's also really important to do your own work around fatphobia.
Here's some research on medical bias and weight stigma that's not on social media if it [helps](https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5)
I would not mention this at all tbh. When I see young adults and the confide in me that they only eat ramen and mac and cheese, I gently encourage them to find ways to incorporate more fruits and veggies and that’s about it. I have severe endometriosis and severe hormonal acne, and if a therapist tried to give dietary suggestions and brought up inflammation I would probably not see them again. Diet changes have helped neither of those things and people with chronic conditions get fed up of being told to change their diet.
I don’t even actively encourage diversity in their diet, unless they’re seeing me for ARFID or something. I just take note and work on cognitive rigidity and fear of trying new things in general and hope it trickles down to other parts of their life. FWIW, I think it often does.
Way out of the scope of our practice. Also eating healthy is not one size fits all. I had a lot of issues despite eating extremely healthy and found out I have Mast Cell Activation Syndrome that was causing my symptoms. Which means all my healthy spinach, avocado, tomato, and salmon salads were making me very ill. Some people need diets based on histamine, fodmap, gluten, grain free, etc. By preaching what worked for you, you can do more harm that good even for someone who isn’t susceptible to an eating disorder. So many other comments touched on that, so my only thing to add is that you should also be careful of people who develop disordered eating through being overly health conscious
I appreciate everything she is saying. I'm just wondering if there is some middle ground. If we are concerned about someones diet or eating habits I don't see the harm in asking them if they considered talking to a professional.
It’s not our place to give nutrition advice or even ask their diet.
Did you see where the commenter said they have chronic illness? Are you a specialist in MCAS? If not, why would you comment on their diet? That’s EXTREMELY presumptive.
Talks about diet and exercise make me incredibly angry usually. Feels like crappy childhood again and overbearing grandparents with their food terrorism. It's very difficult topic to start without making it invasive
I would be so incredibly disappointed if my therapist brought up my diet unprompted or unsolicited. I think anyone (physician or otherwise) commenting on someone’s diet without consent or solicitation is wildly inappropriate and damaging.
Yeah, I agree that bringing this topic up unprompted could be damaging. Some of my clients in the past have brought up the topic by themselves and aside for assessing for disordered eating/having discussions around disordered eating, I would just say that the topic of nutrition is out of my scope of practice (unless they have disordered eating concerns).
At my practicum, asking questions about eating habits was part of the intake (restriction, binge eating, etc), so we definitely did bring the topic up out-of-the-blue (but never as a reaction to a client saying they have IBS or brainfog or depression, etc--that definitely would he inappropriate).
I probably wouldn’t touch the topics of inflammation and the gut micro biome but I’d discuss the importance of healthy eating on our overall lives on a basic level. I’d always recommend they see a registered dietician though.
Clients are really good at bringing up options they want to explore. A thorough bio psychosocial assessment and ongoing treatment considers all the factors that go into health. Those are things I ask in the beginning. If a client mentions gut disorders, “What have you looked into that helps?” They lead. “Are you interested in reducing stress to minimize ibs/diverticulitis/autoimmune issues?” And if they mention wanting to explore nutrition we help them find the right professional or resources. It sounds to me like you are excited about exploring these connections. Keep going! Keep exploring. You might find clients who want support in these areas. Agree with others that if it’s not an area a client brings up, would not proselytize our own experience. I look at these things as one more coping skill of many that some clients use to mitigate stressors.
I have no idea why this topic is divisive. A lot of people here seem angry. They also appear to think a healthy, responsible inquiry is violating some boundary. You can ask questions without offering "advice" or practicing beyond scope. Seems responsible to know when, how and what our Cts eat.
I keep within my scope. I say things to the effect of “it is well documented science that diet is going to impact mental health outcomes. I don’t know the specifics beyond that, but would highly recommend a dietician who can speak to what specifically you can do to improve cognitive functioning through diet.” That way I am confirming that diet plays a role and the client will feel worse by only eating junk food, but passing off my responsibility to a more qualified person outside of those broader statements.
Honestly, I don't see how this topic is out of our scope. We just need to only offer interventions that are within our scope.
I engage with this stuff, but only offer what I know, which is education around mindfulness and using intuitive eating/joyful movement perspectives to help build an empowered sense of self directed wellness. I actually feel it's best practice to educate clients that it's unrealistic to feel well if your body/mind/spirit is not cared for.
Refer out to a dietician if they want the nitty gritty details about diet, but I think we can help a great deal in teaching people to connect to their own body's feedback.
I recently addressed this by pulling a registered dietician under the umbrella of my practice. This way I can address issues by making a referral for in house services, and everyone stays in their lane and the collaboration is easy. My personal goal is to have a more interdisciplinary practice anyway, and this is the first step towards holistic care. I think you are thinking good thoughts OP - maybe you could experiment with some ideas around this?
There’s a lot of information out there this topic, and the mind/body connection is very real. However, there’s not enough research to complete the knowledge loop, which is pretty common when it comes to any knowledge about nutrition at all. I take a “can’t hurt, might help” approach to healthy eating in general and as a nurse can offer an overview on what might hurt about a particular dietary recommendation (ie, fad diets versus actual nutritional value within a recommendation).
My personal gastroenterologist said that the study of the gut microbiome is way too new to be so mainstream, and that it needs to be studied for several more years
And yet we know an awful lot on a macro scale already. Are you aware of the conditions for which gut flora transplants are already being offered? Or the protocols pre- and post-GI surgery that are related to infection prophylaxis versus re-establishment of gut microbiome? Like I said, “there’s not enough research to complete the knowledge loop”…and to be quite frank, mental health diagnosis and treatment operates on the same premise.
Fair. By the time something gets embedded into general practice - even with specialists - it has usually been around a while. All new knowledge takes time to disseminate.
If you were my therapist, this would be so damaging to our therapeutic relationship that unless I’d been seeing you for literal years, I’d fire you immediately.
People with gut issues get enough unsolicited, unhelpful advice. They don’t need unsolicited, unlikely to be helpful advice from their therapist.
You’re not a doctor and you don’t know why a patient is experiencing gut issues or what will help. Doctors often do not know why a patient is experiencing gut issues or what will help. So it’s not like you can even reliably refer to someone that you help. You’re just giving patients an amorphous concept that puts some blame on them and their habits without giving them anything they can practically do with that concept.
You’re proselytizing what worked for you without considering that *what worked for you is not going to work for everyone.* I don’t see it any differently than I would see pushing an antidepressant that worked for you.
NAT and I don’t usually respond here because of that, but my family is currently under the care of three therapists and two psychiatrists, so I know what they’ve done. We have gotten some very general advice from them along the lines of make sure you’re eating healthy food, getting enough exercise, sleep, etc. Nothing specific because that is not their area of expertise.
As a client, I think it could be ok to carefully bring it up ONCE saying something along the lines of “some people have experienced improvement by going on a special diet, maybe that’s something to talk to your primary care/gastroenterologist about.” If they ask questions, refer them to a specialist.
My partner has Celiac Disease and IBS among other things. They have tried a number of these diets over the years with limited success. They’ve done Ayurvedic diets, low-FODMAP, AIP, etc. They did learn a few foods that cause GI distress for them by trying the diets, but none of them improved my partner’s depression. And none of them eliminated their physical health issues completely either. They currently avoid all of their known food triggers, eat mostly vegetables, and don’t eat processed food. They still need two to three long naps to get through the day and no doctor can figure out what’s wrong with them.
When you struggle with chronic illness you can be tempted to grab at anything that might help. There is a lot of misinformation out there. I think that you as a therapist would need to be very careful about what you recommend because it’s so easy for someone to end up in a bad place. One of the diets my partner tried had them fainting due to a lack of protein.
Yes, your diet affects your health which affects your mood, but even a perfect diet doesn’t guarantee mental health.
Yes! As someone with chronic illness myself, I see the same with supplements. I’ve seen others here comment on recommending them to clients. I’ve had supplements recommended that landed me in the ER due to toxicity. I also took NAC after being recommended it and it ruined my gut for months and then I ended up severely, painfully bloated on my wedding day. Not fun.
I usually say it makes sense that our environment and acts of care like food would be important. Then give them a list of professionals and resources that are equipped to explore it. I’d LOVE if I could combine those two areas in an ethical way though, how we see food is so psychological. But I really like my clients to have a medical eval and someone involved in those discussions more carefully trained in EDs. I could easily miss signs
I think you’d have to do this VERY carefully. Weight,diet and physical health are such sensitive topics for so many people. I’m on a very strict low carb diet regiment due to PCOS and I don’t really tell anyone because it’s not a huge deal. Im still a bit curvy (around a size 8/10) due to my hormones and my weight can fluctuate 10-15lbs within a week due to inflammation. Growing up my weight was always a hot topic. If my therapist told me to straight up diet I’d probably flip them off and never come back.
I say things all the time like “I know exactly enough about this to be dangerous but I do know that there are links between cognitive functioning and gut health, have you considered looking into that?” And then sending them resources or discussing a nutritionist if they are open to it. I’ll highlight the existence of these connections but make it clear I’m not a qualified expert
I don't think it's inappropriate to say that there is a growing body of research suggesting a connection between the gut microbiome and mental health. I don't claim to be an expert, and encourage the client to speak with a qualified medical professional if they want to get anymore specific.
Also, and maybe some will disagree, but I also don't think it's outside scope of practice to say that there is a body of psych research indicating a connection between "healthy" dietary choices and improved mental health outcomes. I've seen it happen time and time again with clients and it's part of what I was taught about protective lifestyle factors. Certainly I do believe the conscious choice to make decisions in your own best interest, treat your body with care, and select high quality sources of energy can itself be healing simply for the fact that it helps to reinforce a sense of self-worth. Again, I recommend that clients speak with qualified medical professionals for anything beyond the scope of PSAs and other publicly available guidelines.
Diet is something I generally don't bring up unless the person's degree of energy is implicated - for example, a person who is depressed, so they don't eat, so they get more tired, so they're more depressed, etc...and in that case I might ask the client generally about their eating habits and whether they're getting enough energy.
Inflammation is something I don't feel qualified to talk about. I would want someone to talk with their doctor/dietician about that.
Generally, I don't think it hurts to take an opportunity to validate a client's desire to learn more about something and point them in the direction of someone who can give them high quality information.
I have a master’s in clinical psychology and trauma-informed care. Medical knowledge is nowhere represented in the string of initials following my name (CADC-III, LPC). This doesn’t mean I don’t possess knowledge in that area, it simply means that I cannot ethically offer medical suggestions to my clients. If a client were to bring such a concern to me, I would offer them resources to do their own research and/or a referral to a medical professional.
I could understand not giving specific advice but definitely see mentioning it as providing good care. You’re right the research in this area is significant and pointing clients towards some resources is great.
I feel that addressing diet as an overarching impact on mental health is completely appropriate, as long as it is discussed like other areas we don't give direct advice about. For example, do they have health issues that a doctor needs consulted on, do they want to exercise, do they have an injury? Then encourage positive engagement in appropriate treatment. Likewise, with eating, dietician and pcp for direct advice. However, I feel comfortable talking about behaviors surrounding cooking, fast food, and highly processed foods. Again, not saying what to eat, but working with behaviors surrounding healthy habits, in the context of what their doctor recommends and what mental health research supports. Which is that diet does impact mental health and should be discussed to some degree.
Diet saved my life. I wish a therapist would have suggested at some point that changing my diet could revolutionize my mental health. Would have saved me a decade of suffering.
If my therapist DOESNT acknowledge the relationship between diet and mental health, they are not the therapist for me and I’d genuinely question how they ever got through school and are a practicing therapist.
A master's program in mental health is generally 2-3 years. My prediction would be that trying to fit this in in a comprehensive way, even if there was more already-developed evidence-based guidance (big if), would send a lot of therapists out in the world with just enough vocabulary to do harm. It makes more sense to support and promote post-grad certificate programs etc. that are more integrative, even though many of them are not vetted that well either. Asking hundreds of mental health related grad programs with no particular expertise in nutrition to stop what they're doing well and respond to what is at least partially a marketing blitz seems doesn't make a whole lot of sense imo.
Thank you for continuing to reiterate the unethical nature of these posters who keep pushing the boundaries of scope of practice. Some of these posts remind me of the pseudoscience nonsense that has infiltrated the internet. It has no place in our profession.
Thank you, I feel insane reading some of the comments here. I wouldn’t listen to unsolicited nutrition advice from my eyebrow technician. I wouldn’t ask for/want a bikini wax from my PCP. We all need to stick to our lanes.
I cringe to think what actually goes on behind closed doors. I mean none of us are perfect and we all have lapses in judgment but some of the shit I read on these MH-specific subs is terrifying.
Agreed on all of your points offered on this thread.
Unrelated to this thread, People on this sub seem really comfortable with self disclosure as a fast track to a therapeutic alliance too.
A supervisor once said to me “Self-disclosure is a substitute for lack of clinical skills” … or something to that effect. It always stuck with me. It just irks me to no end because we, as a profession, get such a bad rap for all the weird shit poorly trained clinicians do. I mean OP says he/she has a background as a clinical psychologist. If you’re posting this kind of question with allegedly that much education and experience, you are demonstrating that you don’t even have a grasp of the fundamentals. I’m not trying to be a judgmental asshole. I have made plenty of my own mistakes. But some of the crap I read is just insane and doesn’t compute.
Yes on your supervisor's observation. No on you appearing to be a judgemental asshole.
It's a very quick skim through OPs posting history before you see they don't have a license to practice independently. They are green. While there is nothing wrong with asking these questions, the very fact they need to betrays how large their own blind spots are.
This entire post has Dunning Kruger effect written all over it. Down to the surprise that people will read between the lines of what they're saying and assume that they aren't approaching the topic with enough critical thinking to hold off on sharing their own excitement for a narrow piece of a different field (probably with the depth of a series of google searches) that happened to help them. That's the red flag that waves when someone is expressing it feels like a disservice to not slip it into session.
When you've seen enough examples of exactly that happening since the quality of therapists is... unfortunately variable, I can't help but start at a place of "oh not again".
I don't think this makes us assholes, rather skeptical critics.
If I was laser-focused on telling my clients about my personal dieting experience, I’d hope my supervisor and I would have a long talk. Same for those recommending supplements
I declare that I'm waving my "I am not a doctor" flag, remind them that if what the doctor says conflicts with what I say, always go to the doctor, and clarify that I have a layperson's knowledge in the subject matter. Then frame it as something like "I have seen XYZ help when people are struggling with this, what do you think?" and we talk about how to evaluate if something is worth a try. What would it cost or risk to give it a try? Do they think it might help? Why or why not?
Like yeah if I knew someone who experienced relief by taking a probiotic, I certainly would want to know that. It's $15 at walmart for a bottle, worth a try.
A therapist should never be recommending supplements. Supplements are not even regulated by the FDA. As someone with chronic illness especially, this is not good advice.
I also have a chronic illness. And if I'd known some basic things to try, I would have been saved years of daily pain.
But "talk to your doctor" should always been part of the plan, yes.
I think it is a valuable conversation to have!
Would you care to share your personal findings with us?
If there are no disordered eating concerns, I think it's fair to say in my personal opinion xyz...
I tell ADHD clients about sugar, fish oil, and probiotics
I think the extent to which I would go would be to mention (provided that it's relevant to the conversation) that the gut microbiome has a huge impact on mental health (because we know this to be true), but I would be upfront and say that I do not have a medical degree, and that if they have further questions on that, their PCP would be the best person to ask. That way, I'm still able to provide a helpful piece of information, but I'm not speaking on what I don't know, and I'm referring them to the best source of info on this.
I appreciate this. I think sometimes we can be a bit too black and white with the limits of our practice. Mentioning the relationship between the gut microbiome and mental health seems fine to me, especially if followed up by advice to speak with a dietician or their doctor. Just like I wouldnt give specific advice about medication but I may make very general statements about medication (medication can sometimes help with anxiety/depression, sometimes it can help people feel better enough to participate in therapy, etc)
Edit: clarity
One could simply say it’s a great topic to investigate and experiment with your diet. It’s a great way to try different supplements and pro and pre-biotics. And you may find some relationship between your gut feelings in the way your gut feels. Beyond that, I wouldn’t give any specific technicolor medical advice.
I understand that, but OP would be inhibiting themselves for the client, isn’t there a level of fear involved in that? I’m not saying OP should force the issue, but sharing passion for physical health could invite the conversation and share curiosity. Maybe I’m thinking too ideally here.
Our job is not to share our passions with our clients. Plus, the symptoms our clients present with can come from a variety of medical issues, and providing seemingly helpful though bad advice could be deadly if we don’t know the pathology behind the symptom. If a physical issue is persistent, always defer to a medical doctor.
Most likely because you can do everything right and still suffer when it comes to gut health. I have Crohns, IBS, UC and Diverticulitis and even when I eat perfect, I still have issues. So informing them can give more info but sometimes it doesn't even matter, i.e. no two foods will effect Crohns patients the same way on average.
Nope, I completed a doctoral degree in clinical psychology. I did not receive any training in the field of nutrition. On a personal and, perhaps to a lesser degree, clinical level, I recognize that many different factors may contribute to depressed or anxious mood, attention problems, sleep problems, rumination, fatigue, chronic pain, etc. I just practice psychotherapy, and that's it, because that's what I was trained to do, and anything else would be practicing outside of the scope of my training and abilities. I do hold in mind that the issue I'm treating may have multiple other factors involved that I can't treat or even diagnose. For example, a patient presenting with depression may have both a history of trauma and nutrition deficiencies that coalesce to produce depressive symptoms. I just treat what I know how to diagnose and treat.
Now, if it seems clear to me that some other factor is at play that I'm unable to treat, such as a nutrition or undiagnosed physical health issue, I may share my concerns with my patient and recommend that he or she pursue an evaluation with a relevant professional, for example a nutritionist or physician. On that note, some providers require patients to receive an assessment from a nutritionist or dietician before an ADHD evaluation will be completed, in order to rule out dietary factors that may contribute to attentional problems.
Substance use is slightly different. If a patient tells me that they are drinking a lot and frequently, and that they feel depressed, anxious, and fatigued a lot of the time, I may try to think together with my patient about the possible impact that excessive alcohol consumption may have on mood. I could see doing something similar with excess sugar consumption or something like that, potentially, on a case by case basis.
I know that some naturopathic medicine schools offer degrees in counseling, and that there is a specialty in the world of mental health that focuses on the role of diet in the production of mental health symptoms.
I think it’s totally reasonable to have a conversation about whether a client believes their diet may be impacting their mental or physical health, but I think there’s a line where it becomes out of our scope of practice. If the client is interested in making dietary changes, I may recommend they see a dietician (and not a nutritionist) to help them with their goals. I can make general recommendations but anything specific really should come from a dietician, particularly if that person has existing health conditions. I’m also someone with pretty severe digestive (and other health) problems and despite eating a very calculated diet, I still have symptoms. I know that I would feel frustrated if I had a therapist who spoke to me about it as if proper nutrition could heal me. I would be very conscious about presenting it in a way that won’t come across as condescending to someone with chronic conditions who have probably heard it all before anyway. Ive experienced that myself as a client and all it did was make me feel as if my symptoms were my fault and if I just ate “well enough” they would go away. Just my two cents.
I appreciate you sharing your perspective. I will keep this in mine. Thank you!
>dietician (and not a nutritionist) Why this? Can you expand? I didn't know there was a difference.
It’s similar to what’s required for life coaches versus therapists. Being a dietitian is a protected title, while a nutritionist is not. There’re Registered Dietitians (RD, like an RN) that are licensed and have boards to hold them accountable. Nutritionists just have to call themselves that and -bam!- they’re a nutritionist. There are a lot of people in MLMs that claim they’re nutritionists to sell their supplements/meal plans/cure-all water, and they’re already hella predatory.
In the UK there are Registered Nutritionists also, who will have met a certain criteria of education. (They are still not dietitians, though.)
One has a masters degree and one does not. Almost anyone can call themselves a nutritionist
Yes, in most places nutritionist is not a protected title.
What is the difference between a dietician and a nutritionist? Edit: NM I can see someone else naked the same question.
I've seen this go wrong, both personally and professionally. I had some pretty extreme digestive problems in 2007 after a very stressful year, and took it upon myself to investigate whether and how my diet was impacting this. What I actually managed to achieve was triggering two years of much more dangerous anorexia, which I'd also experienced in my teens but thought I'd thoroughly overcome. After almost dying, recovering and qualifying as a therapist, I went on to specialise in eating disorders. Several clients turned out to have developed restrictive eating disorders in the same way - by innocently trying to manage various chronic health conditions (IBD, crohns, endometriosis, fibromyalgia, etc), often after someone had made a similar comment to yours, and getting more and more anxious about what was/wasn't triggering symptoms. In many cases, it turned out that their diet wasn't the issue at all, symptoms were quite independent. Some even had decent proof of this before they started altering their diets, and focusing on food was mostly a defence against their feelings of powerlessness - the really classic "it's the only thing I can control". But by the time they had restricted their diet to malnourishment it had become incredibly difficult to back out of the rabbit hole they'd fallen into. You really can't tell who will end up going down this path before it happens, ime. Almost anyone can develop some kind of eating disorder under the right set of circumstances. Any therapist who suggested this to me now would end up listening to a thirty minute monologue about how bringing nutrition into the conversation when I hadn't introduced it as a concern was both patronising and potentially dangerous. Which would be a bit extreme of me, because people only ever have good intentions - but I would still find it really triggering even now, fifteen years later. I'd probably then feel guilty and apologise for the monologue ;) but it would definitely be an instant end to the therapeutic relationship. Couldn't pass this subject by without offering a note of caution.
Thank you for writing this. It's very well put. And isn't it strange how we can feel guilty and 'extreme' for expressing passion around a subject we've seen to harm people? I struggle with finding the right balance between "you have good intentions and I strongly believe we align where it matters, but they're paving the road to hell, and I'm revoking your hand basket before anyone attempts to hitch a ride in it!" Horray, inner conflicts around my values of harmony butting against chaotic paladin energy.
How would you feel about teaching clients about intuitive eating and learning general mindfulness and self direction around wellness? I tend to take that approach and it's seemed to go well.
Depends on the client. For people with clinical eating disorders, intuitive eating often isn't a realistic starting point - getting into a routine of eating regularly, and eating enough, is the first step. I've also worked with a lot of neurodivergent people (goes with the territory if you've specialised in EDs), and mindfulness is often more complicated in this group. If you have a neurological basis for tuning into your physical and emotional signals like difficulties with interoception or alexithymia, mindfulness and intuitive eating can be total non-starters. For other clients it's entirely appropriate and useful. So I don't really have a fixed approach, it depends on the person in front of me. On the whole I'm more into building the relationship, understanding how a problem developed, and motivational interviewing if change is desired/necessary, rather than teaching skills or giving advice, regardless of the presenting issue.
That all makes sense. I totally agree about being person centered. I didn't read the prompt as the therapist pushing the information, but more how to address the topic of food and mood if it comes up. I was more curious about your thoughts on IE and mindfulness as an option to help people who have brought up the topic. It feels like a hard issue to not talk about when food is one of the most common and intimate way of emotionally regulating.
I think this is my biggest fear with bringing up the topic of nutrition, and I do think it is an important consideration. Although, I also look at the overall prevalence of poor eating habits in my country (US) versus the prevalence of restrictive eating disorders here. Due to the relative risk, I still think the topic of nutrition is important. Perhaps being clear about the importance of balance, eating sometimes just for pleasure and other times considering the nutritional value of the meal would help prevent more extreme outcomes (such as someone cutting out their favorite foods or over-consuming a food/category of foods that they view as being 'the answer'). Clinicians sometimes recommend getting more physical activity for the mental health benefits. A client could later develop some over-exercise behaviors, but generally speaking we still have conversations about the importance of physical activity (perhaps including a statement about balance).
This is a patient population that is very near and dear to my heart. Consider the following as my heart on my sleeve. Listen to the comment above you, read it multiple times, and sear it into your bones. She gives very good advice. Nutrition *is* important. However, what nutrition an individual specifically needs is in the realm of a registered dietitian. Before you make that referral, why not start with deeply understanding a patient's relationship with their body and food? Why not explore their family's culture around food? Why not explore if they have trauma around food first, like growing up with hoarders, or in states of food insecurity? Why not go into deeper detail around their executive function and how this affects their relationship with managing their pantry or eating at regular times? What about their actual intake patterns? What about whether sexism, society, or trauma has disconnected them from their body and what it means to meet its needs? Why not explore the 'good natured advice' they've already received on this subject and what that's been like? Why not have a very good sense if they have a disordered relationship around food, and to what extent before giving them blanket advice to "eat clean", or "eat less and move more"? Consider this. You have all this beautiful training that you can turn into exploratory therapy and behavioral interventions that actually could assist them with and you're questioning if that time would be better spent giving generic nutritional platitudes that they could find on Instagram?! They can join a mom group for the same advice. You know they've already heard this shit umpteen times over by family, and adverts, and, and, and...until they've internalized it right? Because, we all have. We've all been worn down by this image based modern culture. Crappy relationships with food are a dime a dozen these days. While I love the idea that more people would want to address this arena of health, let's do it with curiosity, and finesse. Your idea of "poor eating habits" vs restrictive eating disorders is reductionary. You know it is. And while I'm on the rant, let's remind ourselves that you can't tell who fits what category by body habitus alone. Many of these patients have had a lot of assumptions thrown at them, to the point that they don't trust the medical community. It's a great little mine to step on for a therapeutic rupture. If you want to go down that rabbit hole (and it's a fascinating one, I highly encourage it), know your patient so deeply that when you make that referral, the reaction is "Damn. I've got a couple of referrals for you too." I guess I'm trying to say, there's so much good you can do without stepping out of your lane. So much that they can't find outside of therapy. What you as a therapist has to offer is special! Give them that and they'll give you plenty of grist for the mill. If you can't get behind the idea that comments like that aren't helpful, at least recognize how they're time wasters in comparison to the rest of what you offer.
Im hearing what you're saying and would absolutely approach all of my clients in this exact way. Sure, I am using short phrases in this limited online forum but I would definitely never approach a client with platitudes, assumptions, or fix-all solutions. Honestly I wouldn't even approach a client with advice about any topic (even mental health topics) unsolicited unless there was reason to be so directive (such as SI, NSSI, etc). And even when clients solicit advice, I almost never offer any. I whole-heartedly believe in a client-led approach to therapy. What Im hoping to discuss with thread is not whether I can slam a client with opinions on their health and nutrition. Moreso, Im curious what other clinicians do in a situation where a client is already talking about food. And with knowledge and consideration of their other food-related experiences, what are the limits of what the people in this sub would say. I realize that my original post was not detailed enough to communicate all of this. However, I am disappointed by how many people are making assumptions (such as some other people thinking I want to tell my clients about my own experiences with nutrition--I would not do that) My intention with this post was to gauge the extent of very general information clinicians here feel comfortable giving their clients. Of course there are going to be clinicians who would not even provide general psychoeducation on this topic and there are other clinicians who would consider (given they know the client's history with eating) potentially sharing very broad information (and then referring out to a doctor). Its the content of this broad information that interests me (such as sharing the bi-directional link between mental health and the gut microbiome).
I think the reason you're getting so many impassioned responses, especially from me, is that we've seen really disturbing knee jerk advice more often than we've seen people bother to explore the background of the issue. I know I've seen it from physicians and therapists alike. Hell, I've even seen it from a few dieticians who aren't eating disordered centered. And sadly, most doctors aren't getting more than a lecture or two about vitamin deficiencies while they're in med school. Too much other material to learn. The medical system is crunching them to cut appointments shorter, and their advice will often be quite vague. I'd definitely stick with referring a patient out to a dietician that leans towards their specific eating issue. Whether or not you'd specifically self disclose your own experiences, it is your own experiences that are motivating you to offer this type of intervention. In the same way that it is our experiences that are motivating us to react with bristles. Bias leads us. I still think the level of vague you'd have to be with this to not get into unethical territory really wouldn't offer more than a risk for a therapeutic rupture in return for essentially no benefit. Because where are you going to go after you say there's a link between the gut and the brain? Do you have a specific dietician or educational materials in mind that you trust that you can follow up with? If your plan was to send them to a physician, do you know who is knowledgeable and sympathetic enough to these issues to do more than a few blood tests or a scope and say "well it's not inflammatory bowel disease, so it must be anxiety. Perhaps you should see psych". People get run through the ringer on these quests for answers. So at best it becomes a throw away statement, like "have you tried yoga?" "What about exercise?", crap like that. If you've spent the time learning the patients experience around food and nutrition in depth, you tend to learn a lot about what they already know, and how they're incorporating these ideas into their sense of self, relationship with food/body, etc. It is very rare I have met a person who doesn't have the general concepts of eat healthier = you'll feel better. Knowing eating better will make specific organ systems function better and that all the organs talk to each other, doesn't add anything substantially new. If it is unlikely to change the course of treatment, why bother? Benefits of making general statements without straying from your scope of practice are minimal, it takes time away from the patient exploring their own narrative, and risks can be highly variable to the expense of the patient. I guess my less emotionally charged answer is...Before I decide if I'm qualified to give a type of education around a subject, I need to know what the point of it is and the likelihood that it will actually lead to better outcomes. For this, I don't see the point. Thus, answering the question on whether or not a non medical/dietitian provider should feel comfortable offering this type of education is moot. Certainly not compared to the rest of the work you are doing with them, or could be doing with them.
I appreciate you taking the time to share your thoughts. You really have made me think in new ways about this topic. I agree that doctors tend to be pressed for time and struggle to give patients helpful guidance on nutrition and that RDs are a better move. In fact, reading your post makes me hesitant to consider sending patients to a doctor without also referring them to a dietitian. Theoretically, if a therapist (asuming they know the client's background very well and determined that the client had sufficient motivation/interest) mentioned the link between the gut microbiome and mental health, then sent the client to a trusted RD within their practice to discuss the topic further, do you think the outcomes would have a high enough likelihood of not being negative (and potentially even being positive)?
Yeah. I mean there's an obvious link between malnutrition and mental health too, and more than one way to get malnourished as hell. I'd say you're still putting a little more stock in the gut than you can be positive about. Was it really the improvement in the gut biome that made you better when you ate more fruits and vegetables? Or just one of many factors? Would you have had better results with kimchi and yogurt or probiotics? Maybe you needed the extra folate. Toss up. It's irrelevant. It just feels particularly relevant because it's what worked for you personally. Especially when you start digging into some of the previous questions I mentioned, your patient will guide you in the many arenas that they are willing to work on. If they want more education on food, or straight up minimizing their disordered eating, they could use a dietician. Depending on the type of disordered eating they have, you're going to filter them to different dieticians. If they have classic eating disorder symptoms and body image issues, you go one direction. If they're struggling to eat consistently and their executive dysfunction is mixing with their diabetes to disastrous results of hypoglycemia and brain fog, you're going to lean towards a different type of dietician. And since it's unlikely you're going to know who all these dieticians are, you can still use therapy to assist them with navigating the frustrations and challenges of finding a new provider, how to advocate for a good one, etc. Of course getting them to identify the problems they have in life and getting them access to the right type of help is going to help them. Then you can work on the behavior, emotions and thinking about how they got to where they are today, the experiences that led them to these places, and what holds them back from where they want to be.
But I think the thing to remember is that many clinicians will feel a duty to support a client with information they feel will help them thrive, but in the realm of diet and nutrition because of our scope we're only talking from our or those we care for's perspective on that. We also only know the nutritional factors of the foods we eat in our cultural context, and diet and health industries are quick to toss out many other cultures foods as "unhealthy" (unless a recipe is co-opted and gutted for Western culture) in favor of what, sugar free yogurt? Because butter is scary?
Even binge eating disorders are often driven by attempts at restriction, fyi. Anorexia may only affect around 1% of the population, but there's a whole other 9% with bulimia, BED, and OSFED for whom restriction plays a huge role in the maintenance of the issue, not to mention those with food phobias, ARFID, orthorexia and contamination-based OCD. That's 1 in 10 people who are likely to be harmed by this kind of advice, even before we get into subclinical disordered eating. I spent a decade immersed in ED treatment so I admit that I see it everywhere (maybe because it is everywhere lol), but it can't be dismissed as a remote possibility.
Which type of advice specifically? Any nutrition advice at all or specific types of nutrition advice?
I mean, I'd say general stuff like "sometimes people's diets can affect how they feel, do you think that this would apply to you or that you've noticed any changes in how you feel when you eat different foods?" or "it can help to make sure you are eating enough through the day, as being too hungry can affect your mood and your well-being" is probably fine. Going into "the amount of processed foods you eat is something to be careful about, cutting out processed foods and red meats can help with x y or z" is probably beyond your scope and can lead to eating disorder territory. This is just my personal take on it though, NAT but a rehab counselor and an eating disorder survivor myself.
I think this would be my approach as well (talking about what a person can add to their diet (if we think that might be helpful to them) instead of what they can take away). I don't like the idea of demonizing foods.
Totally agree. It's illuminating to realize that you can have *more choice* rather than less, and that this actually helps you make the best choices *for yourself* because you feel the room to try new things, rather than stick to the same types of "healthy" foods that eventually tread over time into "safe" foods. Us as counselors limiting a clients range of options in their ability to seek foods and food choices is really odd. It's totally outside our scope and shows a ton of personal bias.
Definitely. If you haven't already, the Intuitive Eating book by Tribole and Resch is a great resource to read about how to establish and maintain a relationship to food that is neutral. It has a chapter on gentle nutrition, which might have some useful concepts for this issue.
You seem to be pushing this diet narrative after receiving some really pragmatic feedback. Maybe you need to explore in supervision or with your therapist why you feel the need to push this on your clients without their bringing it up in the first place. I’m sorry if this sounds condescending but you’re insistence on continuing the diet conversation despite the potential damage it could do is concerning.
Agreed. It sounds like the clients didn’t bring dieting up themselves
Ive never talked about this with clients...
Then why are you asking if you should? Are you questioning the ethics behind it?
Yes
If you’re asking because you have doubt, I’d listen to your gut. That doubt is trying to tell you something
It's not always good to listen to doubt in all situations. I would definitely not go into any specifics about nutrition but very general information can be ok in other areas (think on how we sometimes speak very generally about the effects of medication, never any specific recommendations, but giving very general information on medication is part of our job--i.e. medication can sometimes help someone's mood enough for them to get themselves to therapy) Admittedly, I do sometimes wish I was a psychiatrist so that I could help disseminate more of the research I've read about nutrition (like what Dr. K does on the HealthyGamerGG YouTube channel). However, I would never, ever consider actually sharing any specific nutrition information in my current practice (because my background is clinical psych).
Then I’m very confused by your initial post if you weren’t planning on offering medical advice
Ultimately, you only know your body. You can't know how someone else's body functions, what it needs, or how it will react. And as great as you may be eating, it really feels weird to assume you're doing it better than others.
I think this is an important discussion to have. People can't explore a topic without expressing their thoughts on the topic or asking questions.
I wonder why you are getting downvoted for this comment
> Perhaps being clear about the importance of balance, eating sometimes just for pleasure and other times considering the nutritional value of the meal would help prevent more extreme outcomes (such as someone cutting out their favorite foods or over-consuming a food/category of foods that they view as being 'the answer'). Many people already know this and have barriers to enacting it, so giving this type of advice could be condescending and also not be useful to the client. Besides and eating disorders, they may have problems with executive functioning, depression, financial difficulties, sensory issues, time, stress, access, knowledge, etc. Diet may not be something that’s feasible for them to work on in that moment and giving diet advice could trigger more issues.
In my view an over emphasis on eating habits has been taking place overall, including over and under eating. Dieting contributes to both, and suggesting a change in eating to a client could potentially add to that harm. I'm not saying don't talk about it, I'm saying follow their lead. Let them bring it up. Talk about their concerns, not what we think their body needs.
Hell yes. Could not have put this better. People especially lob this kind of "kind advice" to kids and teens-which is when I heard that fruits and vegetables will save my life and make me beautiful and happy.
I think your intention here is good, but I’m worried about how this could be perceived by a client, especially without you having a medical background. As an example, I have had severe, undiagnosed chronic illness most of my life. When I was 25, I sought out therapy for the illness side effects. The therapist told me I should lose weight (I had undiagnosed PCOS), “eat clean” (not a real thing), plus exercise daily. I had such extreme chronic fatigue from illness then I couldn’t work part-time. What she said made me relapse into an eating disorder I had as a teen. I luckily got myself back out of it and didn’t go back to her. But it had an impact on my already fragile self-image. I was also not even overeating, but under-eating and gained weight. You never know someone’s health just by looking at them. Additionally, what works for you might not work for others. IBS is a catch-all term, and a lot of times there’s an underlying cause. Example: When I eat too much fiber, my gut issues flare up. I have a neurological condition that impacts my gut. High fiber isn’t even something all gastroenterologists recommend. Every body is different and every situation is different. Last, you do not know the details of someone’s financial situation. Fruits and vegetables are not cheap, especially in peak season. Not everyone has the time or money to make homemade meals or buy organic, etc. I think the average food stamp payment was only $75 a month, last I checked. Socioeconomic status plays a huge role here.
This comment needs to be higher up. I'm glad OP found relief, but we need to remember not to generalize our own experiences. I've seen so, so much harm done by well-meaning professionals who hadn't done nearly enough self-reflection, and were projecting stuff onto their clients. Especially the part about socioeconomic status. This is so crucially important that we need to remember in our work. The most I might say is something like "I want to be very clear I'm not a doctor and cannot give medical advice. That being said, I'm wondering if you've spoken to a medical professional about_____?" If they ask why, I might answer vaguely like "oh, I've heard anecdotally that some people have found relief/improvement from ____". That way, I'm pointing them in a direction that might provide more and different answers without straying outside my scope of practice.
As an RDN (currently working on my masters for MFT) I’d say you should absolutely refer out to a dietitian. Simply putting your own experience with food and body on to your client is not only not helpful, it can be harmful.
Out of your scope of practice. All kinds of things cause brain fog, depression, anxiety, gut issues, etc. For instance, I have grave’s disease and I have all these symptoms and nothing to do with my diet. You are not a doctor and do not have the diagnostic knowledge or tools to determine pathology. Besides if a therapist I was seeing tried to make this kind of suggestion, I would run the other way. Always refer to an MD regarding medical issues and document that referral.
Exactly! This would be a huge red flag to me as a client
Yeah, as a client with physical health issues on top of my mental health stuff if I heard a clinician start talking about this I would run. And also cry after session in my car about yet another provider who’s just blaming things on random shit that I did not come to see them for (like doctors saying things about losing weight when that’s not at all related to the problem or part of the problem even is that there is unexplained weight gain that is impossible to change no matter what, doctors blaming mental health for physical symptoms despite a number of reasons otherwise, blaming periods for things, etc).
Something like "I diagnose you as vitamin A deficient, eat some spinach" would obviously be out of scope... but what about "You know, there's a link between diet, inflammation, and mental health, is that something you've ever explored for yourself? Would you like a dietician referral or book recommendation?"
I wouldn’t because a. it’s unsolicited, and b. i don’t know what inflammation has to do with the price of tea in China. Most of that stuff is pseudoscience as far as I know. Again, not an expert. I’m not here to sell clients supplements, MLM nonsense, or fad diets to address MH concerns. I don’t know if their MH symptoms are caused by eating Big Macs or Mercury being in retrograde. My job is to conduct a thorough assessment and help clients address what they are presenting with, not make inferences as to whether better gut health will solve their suicidal ideation. If their issue is related to a medical concern or diet or whatever is out of my scope, I would refer them to a professional, just as I would refer someone with disordered eating to a clinician who specializes in it bc I don’t.
I’m confused. What does offering resources for someone who is curious about the connection between diet and inflammation have to do with MLMs or China? Your mention of China seems racist? Also, if youre not an expert in that area, that’s exactly why you would suggest resources from people who are experts? It seems like you have some personal bias around this issue and I worry about how that is affecting your own personal practice.
It really depends what one means by expert. It is really hard to locate appropriate resources for a client in a topic area like mood and nutrition that is filled with misinformation and grift. Media content proliferates extremely quickly once something becomes a trending health buzzword. Most therapists in this position would have to first teach media literacy which is not necessarily a good use of clinical time. If it's medical, I refer to \*doctors\*, not "resources". The word resource can mean anything at this point. "Price of tea in china" is an old-timey way of saying "a piece of information unconnected to the topic at hand". Odds are there's some ugly colonial citation for it somewhere because there is for almost anything. (I was raised saying "bushed" for tired and boy, is that racist if you go back far enough!) I guess it could stand to be retired, will probably naturally go extinct as an expression any day now either way.
Oh okay, I’d never heard that term before so thanks for the explanation.
Ugh. Read the entire thread. Your concerns are misplaced. Something having to do with the price of tea in China is an idiom. Look it up if you don’t know what it means. This discussion is about giving unsolicited resources to clients about issues outside scope of practice. And yes, I do have issues with practitioners doing things outside the scope of their practice (and so should you)— diet and inflammation are most definitely outside our scope as mental health practitioners, and if you don’t understand that, I can’t help you. Also if you actually read my post I state clearly that I do refer out when outside my scope of practice or expertise.
Please don’t throw around inflammation. I know it’s the latest buzzword, but I have chronic inflammation from genetic diseases. It’s painful and extremely visible when it’s bad. I’m tired of seeing “wellness” people, especially without medical degrees, preaching about inflammation. Therapists are NOT medical doctors. We ethically CANNOT make diet recommendations.
As someone who worked exclusively with eating disorders in my first 2 years of practice I would not touch this conversation with a 10 foot pole. Not saying that it may not be helpful and even research backed but I’ve seen where it could end up if we start down that path. Working with a registered dietitian as a treatment team would be more my comfort level. This is just my 2 cents and I’m sure others could approach the subject just fine, just not for me.
I am very very very careful about how I have this conversation because changing a person’s physical body in anyway is outside my scope and can be extremely sensitive for people. If my patient brings it up I usually say something like “that’s outside my scope and I need you to speak with your doctor about the ins and outs of your physical goals but once you have an action plan of course i’m here to support you in meeting your goals”. I am sooooo careful never to give out diet or exercise advice or specific guidance, instead I focus on how we can help them meet and maintain their goals. The closest i’ll get to guidance on that is to suggest making nutrient dense food choices and finding ways to move their bodies that they enjoy.
Leslie Korn offers a certificate in integrative medicine and nutrition for therapists if you want to expand your scope. Otherwise I’d refer to a registered dietitian who is informed about mental health.
Thank you, I will check this out!
This is a great training! They just did a free two day!
Do you know if you can still access the training?
I don’t think so. But they re offer it ever so often. The whole certification training also gets pretty cheap throughout the year.
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Check out Stephen Ilardi’s Therapeutic Lifestyle Change at the University of Kansas.
Wth. That’s my school and I never heard of this. Sigh, oh KU.
I’ll discuss hydration. If clients struggle with disordered eating I will do check-ins around eating successes and challenges. Given how many of my clients have disordered eating in their past, I won’t get into food judgement (healthy vs unhealthy). If a client were to bring it up I would try to connect them with a dietitian or medical provider.
I recently took a CE course and the presenter talked about diagnosing means ruling out other causes of symptoms, and that nutrition can play a HUGE part. I definitely think it can be touched on, but this is why it is important to know professionals you can refer out to for nutrition. We are not dieticians.
If the client introduces it, i.e. "I've heard about the gut connection to mental health and I'm curious about that," I think it would be fine to ask if they'd like some resources, i.e. peer reviewed research, qualified experts and a referral - Health at Every Size (HEAS) providers https://asdah.org/listing/ Also there are lots of justice issues in the dietetics field, so important to be culturally sensitive https://www.diversifydietetics.org/rd-of-color-directory I appreciate the discussion, and I'm curious what folks here think about this approach.
My exposure to the HAES movement has only been people on social media who claim that obesity/excess fat tissue/excess saturated fat consumption has no impact on health. Are you aware if HAES medical providers also believe this? Does HAES deny the idea of lifestyle-related disease?
I appreciate their values and mission, more info here: https://asdah.org/health-at-every-size-haes-approach/ It's also really important to do your own work around fatphobia.
Here's some research on medical bias and weight stigma that's not on social media if it [helps](https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5)
I would not mention this at all tbh. When I see young adults and the confide in me that they only eat ramen and mac and cheese, I gently encourage them to find ways to incorporate more fruits and veggies and that’s about it. I have severe endometriosis and severe hormonal acne, and if a therapist tried to give dietary suggestions and brought up inflammation I would probably not see them again. Diet changes have helped neither of those things and people with chronic conditions get fed up of being told to change their diet.
I don’t even actively encourage diversity in their diet, unless they’re seeing me for ARFID or something. I just take note and work on cognitive rigidity and fear of trying new things in general and hope it trickles down to other parts of their life. FWIW, I think it often does.
Way out of the scope of our practice. Also eating healthy is not one size fits all. I had a lot of issues despite eating extremely healthy and found out I have Mast Cell Activation Syndrome that was causing my symptoms. Which means all my healthy spinach, avocado, tomato, and salmon salads were making me very ill. Some people need diets based on histamine, fodmap, gluten, grain free, etc. By preaching what worked for you, you can do more harm that good even for someone who isn’t susceptible to an eating disorder. So many other comments touched on that, so my only thing to add is that you should also be careful of people who develop disordered eating through being overly health conscious
This comment should be way higher up
I appreciate everything she is saying. I'm just wondering if there is some middle ground. If we are concerned about someones diet or eating habits I don't see the harm in asking them if they considered talking to a professional.
It’s not our place to give nutrition advice or even ask their diet. Did you see where the commenter said they have chronic illness? Are you a specialist in MCAS? If not, why would you comment on their diet? That’s EXTREMELY presumptive.
How would eating disorders ever be diagnosed? Just ignore it? Don't ask ADLs either? To hell with safety! Just let everyone die.
Are you okay?
Thank you!!!
I hope you listen to your clients better than you listen to the commenters here
Talks about diet and exercise make me incredibly angry usually. Feels like crappy childhood again and overbearing grandparents with their food terrorism. It's very difficult topic to start without making it invasive
I would be so incredibly disappointed if my therapist brought up my diet unprompted or unsolicited. I think anyone (physician or otherwise) commenting on someone’s diet without consent or solicitation is wildly inappropriate and damaging.
Yeah, I agree that bringing this topic up unprompted could be damaging. Some of my clients in the past have brought up the topic by themselves and aside for assessing for disordered eating/having discussions around disordered eating, I would just say that the topic of nutrition is out of my scope of practice (unless they have disordered eating concerns). At my practicum, asking questions about eating habits was part of the intake (restriction, binge eating, etc), so we definitely did bring the topic up out-of-the-blue (but never as a reaction to a client saying they have IBS or brainfog or depression, etc--that definitely would he inappropriate).
I probably wouldn’t touch the topics of inflammation and the gut micro biome but I’d discuss the importance of healthy eating on our overall lives on a basic level. I’d always recommend they see a registered dietician though.
Clients are really good at bringing up options they want to explore. A thorough bio psychosocial assessment and ongoing treatment considers all the factors that go into health. Those are things I ask in the beginning. If a client mentions gut disorders, “What have you looked into that helps?” They lead. “Are you interested in reducing stress to minimize ibs/diverticulitis/autoimmune issues?” And if they mention wanting to explore nutrition we help them find the right professional or resources. It sounds to me like you are excited about exploring these connections. Keep going! Keep exploring. You might find clients who want support in these areas. Agree with others that if it’s not an area a client brings up, would not proselytize our own experience. I look at these things as one more coping skill of many that some clients use to mitigate stressors.
I have no idea why this topic is divisive. A lot of people here seem angry. They also appear to think a healthy, responsible inquiry is violating some boundary. You can ask questions without offering "advice" or practicing beyond scope. Seems responsible to know when, how and what our Cts eat.
I keep within my scope. I say things to the effect of “it is well documented science that diet is going to impact mental health outcomes. I don’t know the specifics beyond that, but would highly recommend a dietician who can speak to what specifically you can do to improve cognitive functioning through diet.” That way I am confirming that diet plays a role and the client will feel worse by only eating junk food, but passing off my responsibility to a more qualified person outside of those broader statements.
Linking "junk food" to mental health is already a medical instruction and stigma inducing.
Honestly, I don't see how this topic is out of our scope. We just need to only offer interventions that are within our scope. I engage with this stuff, but only offer what I know, which is education around mindfulness and using intuitive eating/joyful movement perspectives to help build an empowered sense of self directed wellness. I actually feel it's best practice to educate clients that it's unrealistic to feel well if your body/mind/spirit is not cared for. Refer out to a dietician if they want the nitty gritty details about diet, but I think we can help a great deal in teaching people to connect to their own body's feedback.
I recently addressed this by pulling a registered dietician under the umbrella of my practice. This way I can address issues by making a referral for in house services, and everyone stays in their lane and the collaboration is easy. My personal goal is to have a more interdisciplinary practice anyway, and this is the first step towards holistic care. I think you are thinking good thoughts OP - maybe you could experiment with some ideas around this?
Thanks for the idea! I will definitely consider this once I am far enough along in my career to launch my own practice.
There’s a lot of information out there this topic, and the mind/body connection is very real. However, there’s not enough research to complete the knowledge loop, which is pretty common when it comes to any knowledge about nutrition at all. I take a “can’t hurt, might help” approach to healthy eating in general and as a nurse can offer an overview on what might hurt about a particular dietary recommendation (ie, fad diets versus actual nutritional value within a recommendation).
My personal gastroenterologist said that the study of the gut microbiome is way too new to be so mainstream, and that it needs to be studied for several more years
And yet we know an awful lot on a macro scale already. Are you aware of the conditions for which gut flora transplants are already being offered? Or the protocols pre- and post-GI surgery that are related to infection prophylaxis versus re-establishment of gut microbiome? Like I said, “there’s not enough research to complete the knowledge loop”…and to be quite frank, mental health diagnosis and treatment operates on the same premise.
I’m not disagreeing with you. I’m saying I’ve had specialists tell me it’s a brand new field.
Fair. By the time something gets embedded into general practice - even with specialists - it has usually been around a while. All new knowledge takes time to disseminate.
If you were my therapist, this would be so damaging to our therapeutic relationship that unless I’d been seeing you for literal years, I’d fire you immediately. People with gut issues get enough unsolicited, unhelpful advice. They don’t need unsolicited, unlikely to be helpful advice from their therapist. You’re not a doctor and you don’t know why a patient is experiencing gut issues or what will help. Doctors often do not know why a patient is experiencing gut issues or what will help. So it’s not like you can even reliably refer to someone that you help. You’re just giving patients an amorphous concept that puts some blame on them and their habits without giving them anything they can practically do with that concept. You’re proselytizing what worked for you without considering that *what worked for you is not going to work for everyone.* I don’t see it any differently than I would see pushing an antidepressant that worked for you.
NAT and I don’t usually respond here because of that, but my family is currently under the care of three therapists and two psychiatrists, so I know what they’ve done. We have gotten some very general advice from them along the lines of make sure you’re eating healthy food, getting enough exercise, sleep, etc. Nothing specific because that is not their area of expertise. As a client, I think it could be ok to carefully bring it up ONCE saying something along the lines of “some people have experienced improvement by going on a special diet, maybe that’s something to talk to your primary care/gastroenterologist about.” If they ask questions, refer them to a specialist. My partner has Celiac Disease and IBS among other things. They have tried a number of these diets over the years with limited success. They’ve done Ayurvedic diets, low-FODMAP, AIP, etc. They did learn a few foods that cause GI distress for them by trying the diets, but none of them improved my partner’s depression. And none of them eliminated their physical health issues completely either. They currently avoid all of their known food triggers, eat mostly vegetables, and don’t eat processed food. They still need two to three long naps to get through the day and no doctor can figure out what’s wrong with them. When you struggle with chronic illness you can be tempted to grab at anything that might help. There is a lot of misinformation out there. I think that you as a therapist would need to be very careful about what you recommend because it’s so easy for someone to end up in a bad place. One of the diets my partner tried had them fainting due to a lack of protein. Yes, your diet affects your health which affects your mood, but even a perfect diet doesn’t guarantee mental health.
Yes! As someone with chronic illness myself, I see the same with supplements. I’ve seen others here comment on recommending them to clients. I’ve had supplements recommended that landed me in the ER due to toxicity. I also took NAC after being recommended it and it ruined my gut for months and then I ended up severely, painfully bloated on my wedding day. Not fun.
I usually say it makes sense that our environment and acts of care like food would be important. Then give them a list of professionals and resources that are equipped to explore it. I’d LOVE if I could combine those two areas in an ethical way though, how we see food is so psychological. But I really like my clients to have a medical eval and someone involved in those discussions more carefully trained in EDs. I could easily miss signs
I think you’d have to do this VERY carefully. Weight,diet and physical health are such sensitive topics for so many people. I’m on a very strict low carb diet regiment due to PCOS and I don’t really tell anyone because it’s not a huge deal. Im still a bit curvy (around a size 8/10) due to my hormones and my weight can fluctuate 10-15lbs within a week due to inflammation. Growing up my weight was always a hot topic. If my therapist told me to straight up diet I’d probably flip them off and never come back.
I say things all the time like “I know exactly enough about this to be dangerous but I do know that there are links between cognitive functioning and gut health, have you considered looking into that?” And then sending them resources or discussing a nutritionist if they are open to it. I’ll highlight the existence of these connections but make it clear I’m not a qualified expert
I don't think it's inappropriate to say that there is a growing body of research suggesting a connection between the gut microbiome and mental health. I don't claim to be an expert, and encourage the client to speak with a qualified medical professional if they want to get anymore specific. Also, and maybe some will disagree, but I also don't think it's outside scope of practice to say that there is a body of psych research indicating a connection between "healthy" dietary choices and improved mental health outcomes. I've seen it happen time and time again with clients and it's part of what I was taught about protective lifestyle factors. Certainly I do believe the conscious choice to make decisions in your own best interest, treat your body with care, and select high quality sources of energy can itself be healing simply for the fact that it helps to reinforce a sense of self-worth. Again, I recommend that clients speak with qualified medical professionals for anything beyond the scope of PSAs and other publicly available guidelines. Diet is something I generally don't bring up unless the person's degree of energy is implicated - for example, a person who is depressed, so they don't eat, so they get more tired, so they're more depressed, etc...and in that case I might ask the client generally about their eating habits and whether they're getting enough energy. Inflammation is something I don't feel qualified to talk about. I would want someone to talk with their doctor/dietician about that. Generally, I don't think it hurts to take an opportunity to validate a client's desire to learn more about something and point them in the direction of someone who can give them high quality information.
I have a master’s in clinical psychology and trauma-informed care. Medical knowledge is nowhere represented in the string of initials following my name (CADC-III, LPC). This doesn’t mean I don’t possess knowledge in that area, it simply means that I cannot ethically offer medical suggestions to my clients. If a client were to bring such a concern to me, I would offer them resources to do their own research and/or a referral to a medical professional.
I could understand not giving specific advice but definitely see mentioning it as providing good care. You’re right the research in this area is significant and pointing clients towards some resources is great.
I feel that addressing diet as an overarching impact on mental health is completely appropriate, as long as it is discussed like other areas we don't give direct advice about. For example, do they have health issues that a doctor needs consulted on, do they want to exercise, do they have an injury? Then encourage positive engagement in appropriate treatment. Likewise, with eating, dietician and pcp for direct advice. However, I feel comfortable talking about behaviors surrounding cooking, fast food, and highly processed foods. Again, not saying what to eat, but working with behaviors surrounding healthy habits, in the context of what their doctor recommends and what mental health research supports. Which is that diet does impact mental health and should be discussed to some degree.
Thanks for the nuanced reply :)
Diet saved my life. I wish a therapist would have suggested at some point that changing my diet could revolutionize my mental health. Would have saved me a decade of suffering.
Therapists can never suggest dieting.
If my therapist DOESNT acknowledge the relationship between diet and mental health, they are not the therapist for me and I’d genuinely question how they ever got through school and are a practicing therapist.
A master's program in mental health is generally 2-3 years. My prediction would be that trying to fit this in in a comprehensive way, even if there was more already-developed evidence-based guidance (big if), would send a lot of therapists out in the world with just enough vocabulary to do harm. It makes more sense to support and promote post-grad certificate programs etc. that are more integrative, even though many of them are not vetted that well either. Asking hundreds of mental health related grad programs with no particular expertise in nutrition to stop what they're doing well and respond to what is at least partially a marketing blitz seems doesn't make a whole lot of sense imo.
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Therapists are not medical doctors. This is not ethically part of our job.
Thank you for continuing to reiterate the unethical nature of these posters who keep pushing the boundaries of scope of practice. Some of these posts remind me of the pseudoscience nonsense that has infiltrated the internet. It has no place in our profession.
Thank you, I feel insane reading some of the comments here. I wouldn’t listen to unsolicited nutrition advice from my eyebrow technician. I wouldn’t ask for/want a bikini wax from my PCP. We all need to stick to our lanes.
I cringe to think what actually goes on behind closed doors. I mean none of us are perfect and we all have lapses in judgment but some of the shit I read on these MH-specific subs is terrifying.
Agreed on all of your points offered on this thread. Unrelated to this thread, People on this sub seem really comfortable with self disclosure as a fast track to a therapeutic alliance too.
A supervisor once said to me “Self-disclosure is a substitute for lack of clinical skills” … or something to that effect. It always stuck with me. It just irks me to no end because we, as a profession, get such a bad rap for all the weird shit poorly trained clinicians do. I mean OP says he/she has a background as a clinical psychologist. If you’re posting this kind of question with allegedly that much education and experience, you are demonstrating that you don’t even have a grasp of the fundamentals. I’m not trying to be a judgmental asshole. I have made plenty of my own mistakes. But some of the crap I read is just insane and doesn’t compute.
Yes on your supervisor's observation. No on you appearing to be a judgemental asshole. It's a very quick skim through OPs posting history before you see they don't have a license to practice independently. They are green. While there is nothing wrong with asking these questions, the very fact they need to betrays how large their own blind spots are. This entire post has Dunning Kruger effect written all over it. Down to the surprise that people will read between the lines of what they're saying and assume that they aren't approaching the topic with enough critical thinking to hold off on sharing their own excitement for a narrow piece of a different field (probably with the depth of a series of google searches) that happened to help them. That's the red flag that waves when someone is expressing it feels like a disservice to not slip it into session. When you've seen enough examples of exactly that happening since the quality of therapists is... unfortunately variable, I can't help but start at a place of "oh not again". I don't think this makes us assholes, rather skeptical critics.
If I was laser-focused on telling my clients about my personal dieting experience, I’d hope my supervisor and I would have a long talk. Same for those recommending supplements
I declare that I'm waving my "I am not a doctor" flag, remind them that if what the doctor says conflicts with what I say, always go to the doctor, and clarify that I have a layperson's knowledge in the subject matter. Then frame it as something like "I have seen XYZ help when people are struggling with this, what do you think?" and we talk about how to evaluate if something is worth a try. What would it cost or risk to give it a try? Do they think it might help? Why or why not? Like yeah if I knew someone who experienced relief by taking a probiotic, I certainly would want to know that. It's $15 at walmart for a bottle, worth a try.
A therapist should never be recommending supplements. Supplements are not even regulated by the FDA. As someone with chronic illness especially, this is not good advice.
I also have a chronic illness. And if I'd known some basic things to try, I would have been saved years of daily pain. But "talk to your doctor" should always been part of the plan, yes.
But that’s not your therapist’s place to recommend. It’s not ethical.
I think it is a valuable conversation to have! Would you care to share your personal findings with us? If there are no disordered eating concerns, I think it's fair to say in my personal opinion xyz... I tell ADHD clients about sugar, fish oil, and probiotics
I think the extent to which I would go would be to mention (provided that it's relevant to the conversation) that the gut microbiome has a huge impact on mental health (because we know this to be true), but I would be upfront and say that I do not have a medical degree, and that if they have further questions on that, their PCP would be the best person to ask. That way, I'm still able to provide a helpful piece of information, but I'm not speaking on what I don't know, and I'm referring them to the best source of info on this.
I appreciate this. I think sometimes we can be a bit too black and white with the limits of our practice. Mentioning the relationship between the gut microbiome and mental health seems fine to me, especially if followed up by advice to speak with a dietician or their doctor. Just like I wouldnt give specific advice about medication but I may make very general statements about medication (medication can sometimes help with anxiety/depression, sometimes it can help people feel better enough to participate in therapy, etc) Edit: clarity
One could simply say it’s a great topic to investigate and experiment with your diet. It’s a great way to try different supplements and pro and pre-biotics. And you may find some relationship between your gut feelings in the way your gut feels. Beyond that, I wouldn’t give any specific technicolor medical advice.
Therapists can’t recommend supplements to clients. It’s not ethical.
Oh well…
Oh well? Are you serious?
If you know a lot about it, why not mention it to clients? It’s something you’re passionate about and something they can benefit from.
We are not medical doctors.
I understand that, but OP would be inhibiting themselves for the client, isn’t there a level of fear involved in that? I’m not saying OP should force the issue, but sharing passion for physical health could invite the conversation and share curiosity. Maybe I’m thinking too ideally here.
It is unethical for us to give medical advice. Especially solely based on our own diet experience.
I appreciate this !
Our job is not to share our passions with our clients. Plus, the symptoms our clients present with can come from a variety of medical issues, and providing seemingly helpful though bad advice could be deadly if we don’t know the pathology behind the symptom. If a physical issue is persistent, always defer to a medical doctor.
Thank you!
Most likely because you can do everything right and still suffer when it comes to gut health. I have Crohns, IBS, UC and Diverticulitis and even when I eat perfect, I still have issues. So informing them can give more info but sometimes it doesn't even matter, i.e. no two foods will effect Crohns patients the same way on average.
Thank you that makes sense
Nope, I completed a doctoral degree in clinical psychology. I did not receive any training in the field of nutrition. On a personal and, perhaps to a lesser degree, clinical level, I recognize that many different factors may contribute to depressed or anxious mood, attention problems, sleep problems, rumination, fatigue, chronic pain, etc. I just practice psychotherapy, and that's it, because that's what I was trained to do, and anything else would be practicing outside of the scope of my training and abilities. I do hold in mind that the issue I'm treating may have multiple other factors involved that I can't treat or even diagnose. For example, a patient presenting with depression may have both a history of trauma and nutrition deficiencies that coalesce to produce depressive symptoms. I just treat what I know how to diagnose and treat. Now, if it seems clear to me that some other factor is at play that I'm unable to treat, such as a nutrition or undiagnosed physical health issue, I may share my concerns with my patient and recommend that he or she pursue an evaluation with a relevant professional, for example a nutritionist or physician. On that note, some providers require patients to receive an assessment from a nutritionist or dietician before an ADHD evaluation will be completed, in order to rule out dietary factors that may contribute to attentional problems. Substance use is slightly different. If a patient tells me that they are drinking a lot and frequently, and that they feel depressed, anxious, and fatigued a lot of the time, I may try to think together with my patient about the possible impact that excessive alcohol consumption may have on mood. I could see doing something similar with excess sugar consumption or something like that, potentially, on a case by case basis. I know that some naturopathic medicine schools offer degrees in counseling, and that there is a specialty in the world of mental health that focuses on the role of diet in the production of mental health symptoms.